OBJECTIVE
To determine the prevalence, type and treatment behaviour of women with urinary incontinence in four European countries.
SUBJECTS AND METHODS
Data were collected using a postal survey which ...was sent to 29 500 community‐dwelling women aged ≥ 18 years in France, Germany, Spain and the UK. Subjects were asked about the type of urinary incontinence they had experienced and their treatment behaviour.
RESULTS
Of the women who responded, 35% reported involuntary loss of urine in the preceding 30 days; stress urinary incontinence was the most prevalent type. The lowest prevalence was in Spain (23%), while the prevalence was 44%, 41% and 42% for France, Germany and the UK, respectively. About a quarter of women with urinary incontinence in Spain (24%) and the UK (25%) had consulted a doctor about it; in France (33%) and Germany (40%) the percentages were higher. Overall, < 5% of the women had ever undergone surgery for their condition. While pads were used by half of the women, there were some differences among the countries.
CONCLUSIONS
Millions of women in Europe have urinary incontinence; the consultation and treatment rates were low in the European countries included in this study.
Introduction and hypothesis
Obesity is associated with an increased prevalence of female stress urinary incontinence (SUI). Mid-urethral polypropylene sling is considered the surgical gold standard ...for treatment of SUI. We reviewed the current literature on efficacy at 1 year (or more) and perioperative safety of synthetic mid-urethral sling procedures for SUI in obese women.
Methods
A systematic search of PubMed, Embase and the Cochrane databases was performed using the MeSH terms “Stress urinary incontinence”, “Overweight”, “Obesity” and “Surgery”. We included 13 full-text papers published from January 1995 to May 2014. We defined two groups of women: non-obese (BMI below 30 kg/m
2
) and obese (BMI above 30 kg/m
2
). Data regarding subjective and objective cure and selected perioperative complications were pooled and compared.
Results
The pooled data from the 13 studies showed that 76.4 % and 74.7 % of non-obese and obese women, respectively, were subjectively cured (
p
= 0.70), and 83.3 % and 79.2 %, respectively, were objectively cured (
p
= 0.56). Bladder perforation was more frequently reported in non-obese women (
p
< 0.01). We did not detect a significant difference in postoperative urine retention or sling excision between the two groups (
p
= 0.36 and
p
= 0.17, respectively).
Conclusions
Cure rates were found to be comparable in obese and non-obese women. Perioperative complications were not reported to occur more often in obese women. The outcomes of sling procedures for SUI appear to be comparable in obese and non-obese women, and counselling of obese women regarding outcomes and perioperative complications can be similar.
Background: Multimodal analgesia may be important for optimal postoperative pain treatment and facilitation of early mobilization and recovery. We investigated the analgesic effect of pregabalin and ...dexamethasone in combination with paracetamol after abdominal hysterectomy.
Methods: One hundred and sixteen patients were randomly assigned to either group A (paracetamol+placebo × 2), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). According to randomization and preoperatively, patients received paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg or placebo. General anaesthesia was performed. Postoperative pain treatment was paracetamol 1000 mg × 4 and patient‐controlled intravenous morphine, 2.5 mg bolus. Nausea was treated with ondansetron. Morphine consumption, pain score (visual analogue scale) at rest and during mobilization, nausea, sedation, dizziness, number of vomits and consumption of ondansetron were recorded 2, 4 and 24 h after the operation. P<0.05 was considered statistically significant.
Results: The 24‐h morphine consumption and pain score, both at rest and during mobilization, were not significantly different between treatment groups. The mean nausea score (P=0.002) was reduced in group C vs. A. The number of vomits was significantly reduced in both group B (P=0.041) and C (P=0.001) vs. A. Consumption of ondansetron was reduced in group C vs. A and B (P<0.001). Other side effects were not different between groups.
Conclusion: Combinations of paracetamol and pregabalin, or paracetamol, pregabalin and dexamethasone did not reduce morphine consumption and pain score compared with paracetamol alone for patients undergoing abdominal hysterectomy. Dexamethasone reduced nausea, vomiting and use of ondansetron.
Objectives: We aimed to evaluate the impact of a first pregnancy and delivery on the prevalence of stress incontinence 5 years afterward. Study Design: This longitudinal cohort study included 278 ...women who were questioned after their first delivery and again 5 years later. Results: The prevalence of stress incontinence 5 years after a first delivery was 30%, and the 5-year incidence was 19%. The risk of stress incontinence 5 years after a first delivery was related to the onset and duration of symptoms after the first pregnancy and delivery in a “dose-response–like” manner. The use of vacuum extraction or episiotomy during the first delivery increased the risk. Conclusions: First pregnancy and delivery may result in stress incontinence 5 years later. Women with incontinence 3 months after a first delivery have a particularly high risk of long-lasting symptoms. Obstetric risk factors are vacuum extraction and episiotomy. (Am J Obstet Gynecol 2001;185:82-7.)
Introduction and hypothesis
Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in ...treating pelvic organ prolapse (POP).
Methods
Based on a search in PubMed, this review focuses on candidate cell types, scaffolds, and trophic factors used in studies examining cell-based tissue engineering strategies to treat POP, stress urinary incontinence (SUI), and the closely related field of hernias.
Results
In contrast to the field of SUI, the use of cell-based tissue engineering strategies to treat POP are very sparsely explored, and only preclinical studies exist.
Conclusion
The available evidence suggests that the use of autologous muscle-derived cells, fibroblasts, or mesenchymal stem cells seeded on biocompatible, degradable, and potentially growth-promoting scaffolds could be an alternative to surgical reconstruction of native tissue or the use of conventional implants in treating POP. However, the vagina is a complex organ with great demands of functionality, and the perfect match of scaffold, cell, and trophic factor has yet to be found and tested in preclinical studies. Important issues such as safety and economy must also be addressed before this approach is ready for clinical studies.
Objective. To perform a systematic review of the effects of estrogen therapy on symptoms suggestive of overactive bladder (OAB) in postmenopausal women.
Materials and methods. This analysis ...involved a literature review of Medline, Excerpta Medica, and the Science Citation Index and a manual search of popular urology, gynecology, gerontology, and primary care medicine journals from January 1969 to December 1999. Articles had to include estrogen and placebo treatment groups, published or original data presented at a scientific meeting and report symptoms suggestive of OAB. This search identified 11 randomized trials and included a total of 430 subjects. Thirty‐six subjects who participated in two crossover studies received both estrogen and placebo and thus are counted twice, therefore 236 received estrogen therapy and 230 were placebo controls. Estrogen was administered systemically or locally as estriol, estradiol, conjugated estrogen, or estradiol and estriol. A meta‐analysis of these studies was performed for all estrogen therapies and then separately for systemic and local therapies.
Results. Overall, estrogen therapies were associated with statistically significant improvements in all outcome variables: diurnal frequency (P = 0.0011), nocturnal frequency (P = 0.0371), urgency (P = 0.0425), number of incontinence episodes (P = 0.0002), first sensation to void (P = 0.0001), and bladder capacity (P = 0.0018). Local therapies had statistically significant beneficial effects on all outcome variables. However, systemic therapies were only associated with significant improvements in incontinence episodes and first sensation to void while nocturnal frequency actually worsened.
Conclusion. Estrogen therapy may be effective in alleviating the symptoms suggestive of OAB. Local administration may be the most beneficial route of administration.
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